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With the winter season on the doorsteps pressures on A&E’s around the country are set to be increasing even further. This is a re-occurring theme and every government has been struggling to address this adequately. The preferred approach to tackle this issue would be to divert unplanned A&E visits to primary care service. Under the Sláintecare programme this is already envisaged by focusing on the need to shift away from the current hospital-centric model of delivering health care to a community based service for primary and social care. Recent studies looked at aspects of primary care access that impact or would be beneficial for diverting A&E visits.

One of those aspects is the proximity to primary care services. This takes into account travel and time costs patients incur seeking unplanned treatment.

The next is opening hours for primary care service in the sense of extended opening hours in the evening and the weekends.

There is also evidence that being able seek treatment without registering or pre-booking has a strong influence on patients’ preferences.

Another factor is eligibility or being able to substitute service with the distinction for medial card holders and private patients.

None of these come as a surprise and reflect higher expectation for delivering a more patients centric health care system. It will be import for policymakers to look at this in the context of truly delivering a more integrated model of care.

The 2019 National Forum on Integrated Care will take place on Wednesday, 6 November in O’Reilly Hall University College Dublin and is hosted by IFIC Ireland in association with the International Foundation for Integrated Care (IFIC), the UCD Centre for Integrated Care and Improvement Studies (UCD CICIS) and the Health Service Executive (HSE), Ireland.

Venue: 6 November 2019, University College Dublin (UCD)

Our submitted Abstract:

Technology enabled consumer-based access to primary care and efficient use of currently available resources in the sector.

Primary Health Care is set to come under additional pressure due to demographic changes primarily through, aging and population increase but also due to positive policy changes through Sláintecare and the limited capacity of current resources providing services into the sector. The inequality of distribution locally as well as nationally poses further challenges. One fundamental requirement to deliver integrated care is the availability of timely and accurate information. A key performance indicator should be the actual population demand of Primary Health Care needs matched against the available supply for care in a given community setting. Such information enables a patient–centric approach that would empower the care seeker to choose their preferred supplier for health services at a time and location suitable to them. In practical terms, this will require any publicly funded primary care service (GPs, community and public health nurses, occupational therapists, speech and language therapists, chiropodists, physiotherapists, counsellors and psychologists) to make all of their availability publicly accessible on a technology platform that is real-time and 24/7. This platform allows the patient to book the service required and tracks the service utilisation. Benefits of having health care providers consolidated on a single technology platform: The care giver has transparency as to the variety of services required and utilised by the care seeker. Detailed statistical evidence of demand and supply in primary care services i.e. when and where there is additional capacity or further investment in services needed. A consumer-based service that is available 24/7 providing real-time information. Maximisation of existing, limited health care resources. Enable care seekers to view and book their preferred provider along with substitution options (public and/or private) should their provider not be available within a contracted timeframe. Empowers patients to choose services based on their specific needs e.g. access to transport, escort, mobility. Health care providers will reduce repetitive administrative tasks, have better patient engagement and effective management of “do not attends” (DNAs). Up-to-date information driving policy change. Although we only examined the interaction of patients with a single provider in the above context, it is envisaged that this could be expanded within certain constrains among health care providers in general. This would further improve patient engagement and integration as the availability of possible care paths can be determined by any primary care provider within and possibly into the acute care sector as well. In summary, there is a real opportunity to look at a more efficient use of primary care resources already available and accessible with a geographical location. There are clear benefits to patient, 24/7 real-time access to availability and available alternatives based on preferences and for providers by minimising missed appointments and free resource from repetitive administrate tasks. This leads to better patient engaged und resource utilisation that benefits all of us.

Abu Dhabi: A unified database will soon
allow for electronic medical records to be shared between all health
care facilities in Abu Dhabi, top health care officials announced in the
capitalon January 23.

The database will be part of the Health
Information Exchange, a centralised electronic platform designed to
enhance health care connectivity. Titled Malaffi, the platform has
already connected 18 hospitals and 65 medical centres and clinics. “The
new database has been designed to reduce errors, duplication of
treatment and testing, and support the efforts of health care
professionals. We are witnessing a new milestone in Abu Dhabi’s health
care sector,” said Abdullah Al Hamed, chairman at the Abu Dhabi’s health
care regulator, the Department of Health.

18 Hospitals already linked to the Malaffi system

Al Hamed was speaking at an event held to
officially launch Malaffi, where it was announced that six health care
providers have already joined the platform. They include public health
provider Abu Dhabi Health Services Company (Seha), Cleveland Clinic Abu
Dhabi, Imperial College Diabetes Centre, Healthpoint, United Eastern
Medical Services and Oasis Hospital in Al Ain.

Public health care facilities in the emirate
have used a shared database since 2008, but information stored on it
was not shared with other facilities outside the Seha network. In
practice, doctors still rely on patient testimonies to develop medical
histories.

65 Medical centres and clinics by Malaff

By the end of 2019, all 2,000 public and
private health care providers are expected to be on Malaffi, which is
being developed in collaboration with Injazat Data Systems, a subsidiary
of Abu Dhabi Government-owned investment firm, Mubadala. It will be
operated by a new project company, Abu Dhabi Health Data Services.

Once complete, the records of more than three million patients will be included on the database.

“The benefits will be substantial, even
though they cannot be fully predicted as this will be the first health
information exchange system in the region. Most notably, patients will
not have to remember all their past medical details. Not only will this
be convenient, but it will also reduce errors when a patient is taken in
for emergency treatment and is not fully alert or conscious,” said Dr
Ben Hanson, senior vice-president for clinical alliances at the Health
Information Exchange.

Officials added that the data generated will also guide authorities to take better public health decisions.

“A linked patient portal will empower patients who will have access to their medical histories as well,” Dr Hanson added.

“[Within the next decade], I believe the UAE
can set up a nationwide platform that will give patients the medical
care they need on time,” said Dr Rakesh Suri, chief executive officer at
the Cleveland Clinic Abu Dhabi.

At present, Dubai is already working to
widen its Salama medical record system. No other country boasts such a
widespread system till date, although Estonia has a birth-to-death
health record system.

Withings, know for it’s fitness trackers and health-wearable’s is presenting the BPM Core as a successor to the BPM blood pressure monitor at the CES 2019.

The BPM Core looks a lot like its predecessor with a similar traditional arm cuff design. It does still have the ability to measure blood pressure and to a clinical grade level. In addition to blood pressure, it will now take ECG (electrocardiogram) readings and can be used to identify serious heart health conditions such as atrial fibrillation.

Another new feature is the digital stethoscope that Withings says can help provide early detection of valvular heart disease. That relates to damage to one of the four heart valves, which could require surgical intervention.

“Early and regular monitoring is key to identifying, preventing and managing heart diseases, the world’s leading cause of mortality which is why we have created a device that can be used every day in the comfort of your own home,” said Eric Carreel, president of Withings.

The sensor-packed device, which also includes a digital microphone, works by the user placing the cuff on the upper arm and pushing the measurement button. It will then take all three measurements within 90 seconds and send the data to the Withings Health Mate app.

Blood pressure readings are displayed on the device itself with cooler-coded feedback indicating whether blood pressure is normal, moderate or too high. For ECG readings, you’ll need to place your other hand on the stainless steel sensors for twenty seconds. The digital stethoscope requires placing the sensor on the chest with the device needing twenty seconds to listen and evaluate your heart.

The BPM Core will work with iOS and Android smartphones and has a rechargeable battery that’s good enough for 100s of measurements off a single charge. All of the data from the Withings BPM Core including audio recordings of the heart can be shared with your doctor or a medical professional.

The Withings BPM Core is set to go on sale in the first half of 2019. Withings states that while this is a medical-grade device, it is currently under review for FDA and CE clearance.

As of 2016 only 15% of General Practitioners working in practices use telemedicine for patient consultation according to a study published on Health Affairs. 11% of physicians used telemedicine to interact with other health care professionals. The study suggest that there is a correlation between the size of the practices and the use of telemedicine. For small practices the financial outlay for implementation has been the most common reason for the lack of adaptation.

The world HCIT market was valued at $125 billion in 2015, and is estimated to reach $297 billion by 2022, with a CAGR of 13.2% over the forecast period. The growth in this market is driven by the increasing demand for patient safety and data accuracy, government regulations promoting the use of HCIT solutions, and the need to curtail healthcare expenditure. However, scarcity of skilled IT professional in healthcare industry & increasing concerns regarding the patient data safety & security are hindering the adoption of HCIT solution. Moreover, an increasing effect of the drivers over restraints is likely to reveal new market opportunities for key players offering HCIT related solutions and services.

Starting in 2019 patients in Germany will consult with an artificial intelligence. The Techniker Krankenkasse is using the App from Ada Health.

Medical advise at your fingertips 24/7. Ada Health is offering this service in Germany for over a year now. With integration of Ada Health into the Techniker Krankenkasse’s own “TK-Doc” App, the symptom assessment technology from the the start-up based in Berlin is becoming part of the German health care system.

In an interview style Ada will collect information about all symptoms. This process in not unlike a face-to-face conversation a GP would have with a patient. Once completed Ada will propose possible causes for the described symptoms and recommends the consultation of a GP if needed. The app AI accesses a knowledge base of thousands of illnesses and symptoms and the underlying medical network is being updated all the time.

Until know user where on their own to assess the final recommendation provided by the App. With the integration into the Techniker Krankenkasse’s “TK-Doc” App, users will now have the option to directly consult a health care professional via telephone, per Email or via Text or Video Chat via the contact centre. The approach gives an indication what directing further developments might take providing alternative access to community care.

As most Western countries Ireland has started to look at the concept of introducing an Electronic Health Record (EHR) at one point in the future. This has been marked as the cornerstone of the eHealth Strategy implementation in Ireland. Some of the challenges with implementing an EHR come from security and integrity concerns in relation to the overall live span of an individual health record. Today’s security mechanisms will be subject to exploitation in the future with the advances in Quantum computing technology. A further aspect is the integrity of the stored health records. Security concepts considered need to address the security and integrity concerns in relation to the requirement that health records will need to be stored over a long-time horizon (decades, even centuries).

Scientists at the TU Darmstadt have developed a solution to address these concerns. In collaboration with Japanese and Canadian partners their project LINCOS (Long-Term Integrity and Confidentiality Protection System) will be piloted in Japan in the coming weeks. LINCOS is utilising the concept of Secret Sharing; data records being broken down into parts that are stored on different servers. Data obtained from a compromised server will not be sufficient to construct usable information. Secondly, the project introduces a cryptographic primitive called long-term commitment to guaranty the integrity of stored health records. Thirdly, to deliver a comprehensive security solution the project proposes the replacement of the encryption step used for securing the communication between Hospitals and database servers with the Quantum Key Distribution (QKD) secure communication method.

eHealth Technology Solutions

eHealth Technology Solutions is enabling Primary Care Service to improve the delivery of care and patients outcomes. Using industry knowledge and experience we are introducing matching technologies to solve day-to-day problems in primary care setting and trying to link into other services to move towards are patient centric health system.

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